Abstract

We present the results of the first study of longitudinal change in HIV-associated risk behaviors in men before and after circumcision in the context of a population-level voluntary medical male circumcision (VMMC) program. The behaviors of 1,588 newly circumcised men and 1,598 age-matched uncircumcised controls were assessed at baseline, 6, 12, 18 and 24 months of follow-up. Despite the precipitous decline in perception of high HIV risk among circumcised men (30–14 vs. 24–21 % in controls) and increased sexual activity among the youngest participants (18–24 years; p-time < 0.0001, p-group = 0.96), all specific risk behaviors decreased over time similarly in both groups. The proportion of men reporting condom use at last sex increased for both groups, with a greater increase among circumcised men (30 vs. 6 %). We found no evidence of risk compensation in men following circumcision. Concerns about risk compensation should not impede the widespread scale-up of VMMC initiatives.

Hallett TB, Alsallaq RA, Baeten JM, et al. Will circumcision provide even more protection from HIV to women and men? New estimates of the population impact of circumcision interventions. Sex Transm Infect. 2011;87(2):88–93.PubMedCentralPubMedCrossRefGoogle Scholar

Milford C, Smit JA, Beksinska ME, Ramkissoon A. “There’s evidence that this really works and anything that works is good”: views on the introduction of medical male circumcision for HIV prevention in South Africa. AIDS Care. 2012;24(4):496–501.PubMedGoogle Scholar

Rain-Taljaard RC, Lagarde E, Taljaard DJ, et al. Potential for an intervention based on male circumcision in a South African town with high levels of HIV infection. AIDS Care. 2003;15(3):315–27.PubMedCrossRefGoogle Scholar